Certified registered nurse anesthetists (CRNAs) have established themselves as leaders in anesthesia care delivery, administering over 40 million anesthetics to patients in the United States each year (AANA 2017 Member Profile Survey). Healthcare employers are increasingly leveraging nurse anesthetist services (2), and CRNAs have contributed both to the reduction of cost for anesthesia care and to increased anesthesia availability, according to the AANA. Nurse anesthetists practice both autonomously and in collaboration with other health care professionals on interprofessional teams, and they are the primary anesthesia providers for rural America, medically underserved populations, and the U.S. military. Licensed as individual practitioners, nurse anesthetists play a role in every type of surgery or procedure and work in all possible practice settings where anesthesia is delivered. In addition to conducting preanesthetic assessments and developing and implementing anesthesia plans of care, CRNAs initiate anesthetic techniques, order and give medications, and manage airways. CRNAs must undergo rigorous training and are educated with a minimum of a master’s degree from a nationally accredited program, however, a doctoral degree may soon become the minimum educational requirement for entry into practice (3).
As a consistent component of the perioperative experience, anesthesia providers are well-positioned to lead in the operating room of a hospital. In the United States, anesthesia services are predominantly provided by CRNAs and anesthesiologists, however provision by a CRNA is subject to unique state law regulations. While CRNAs are responsible for their clinical decisions on the provision of anesthesia in all situations, some states require physician supervision of CRNA practice or require that CRNAs practice in collaboration or cooperation with a physician (4). Subsequently, different delivery models exist for anesthesia services, and research has shown that a CRNA working as the sole anesthesia provider is the most cost-effective (5). The legislative changes enabling unsupervised CRNAs to independently practice anesthesia have led to some conflict between anesthesiologists and CRNAs concerning the acceptable scope of CRNA practice (6). However, there is no difference in mortality or complication rates when CRNAs practice without supervision (7).
Although discussion continues on the best strategy for anesthesia care delivery, CRNAs are invaluable to anesthesia administration in the U.S. and play a crucial role in the perioperative clinical environment. The operating room environment highly affects teamwork in anesthesia, which is essential for positive patient outcomes and requires collaboration and mutual understanding between the different professionals working closely together (8). Due to their extensive experience in participating and managing complex teams consisting of a variety of professionals from other departments, CRNAs have advanced capabilities for leadership. While many states still require that CRNAs practice with physician oversight, barriers to autonomous practice must be addressed. The provision of anesthesia services by unsupervised CRNAs does not put patients at increased risk, and CRNAs offer a cost-effective solution to rising healthcare costs without compromising the quality of healthcare services. Their educational preparation, good outcomes, and extensive scope of practice and experience enhance CRNAs’ capacity for strong leadership in the operating room. Nurse anesthetist leadership should therefore be maximized, as research has shown that CRNAs are capable of providing the same required level of service as anesthesiologists at a potentially lower cost (9).